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Computerised provider order entry and residency education in an academic medical centre.
Med Educ. 2012 Aug; 46(8):795-806.ME

Abstract

CONTEXT

Many academic medical centres (AMCs) have introduced institutional policies, changed processes of care and implemented new technologies to improve health care quality. The impact of such changes on medical education has received little attention. We examine the impact of computerised provider order entry (CPOE) on the educational experiences of medical trainees who work and train in AMCs.

METHODS

We conducted semi-structured interviews of postgraduate trainees and attending physicians in internal medicine at five AMCs (two with CPOE, three without CPOE). Trainees routinely rotate from CPOE to non-CPOE AMCs, whereas some attending physicians work at both types of AMC and are therefore well positioned to reflect on differences between CPOE and non-CPOE learning environments. Data collection and analysis used grounded theory methods. We sampled purposively until we achieved theoretical saturation.

RESULTS

Our study included 11 residents and six attending physicians. Computerised provider order entry had both positive and negative impacts on five aspects of postgraduate training: (i) learning (better for medication interactions and availability of learning resources; worse for learning medication doses); (ii) teaching (more medication information available to enhance case discussions; fewer face-to-face teaching opportunities); (iii) feedback (improved ability to observe medication ordering behaviours to inform feedback; less provision of direct feedback); (iv) clinical supervision (facilitates efficient and safe supervision from a distance; may impede trainee independence), and (v) trainee assessment (increased opportunity to assess clinical decision-making and organisational skills).

CONCLUSIONS

We identify five key educational themes that are positively and negatively impacted by CPOE. These themes form a conceptual framework that could be applied to define the educational impact of other health care quality and patient safety practices. This will help educators to identify educational opportunities and protect the safety of the training experience of residents in AMCs.

Authors+Show Affiliations

Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. brianm.wong@sunnybrook.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22803757

Citation

Wong, Brian, et al. "Computerised Provider Order Entry and Residency Education in an Academic Medical Centre." Medical Education, vol. 46, no. 8, 2012, pp. 795-806.
Wong B, Kuper A, Robinson N, et al. Computerised provider order entry and residency education in an academic medical centre. Med Educ. 2012;46(8):795-806.
Wong, B., Kuper, A., Robinson, N., Morra, D., Etchells, E., Wu, R., & Shojania, K. (2012). Computerised provider order entry and residency education in an academic medical centre. Medical Education, 46(8), 795-806. https://doi.org/10.1111/j.1365-2923.2012.04317.x
Wong B, et al. Computerised Provider Order Entry and Residency Education in an Academic Medical Centre. Med Educ. 2012;46(8):795-806. PubMed PMID: 22803757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Computerised provider order entry and residency education in an academic medical centre. AU - Wong,Brian, AU - Kuper,Ayelet, AU - Robinson,Nicole, AU - Morra,Dante, AU - Etchells,Edward, AU - Wu,Robert, AU - Shojania,Kaveh, PY - 2012/7/19/entrez PY - 2012/7/19/pubmed PY - 2012/12/10/medline SP - 795 EP - 806 JF - Medical education JO - Med Educ VL - 46 IS - 8 N2 - CONTEXT: Many academic medical centres (AMCs) have introduced institutional policies, changed processes of care and implemented new technologies to improve health care quality. The impact of such changes on medical education has received little attention. We examine the impact of computerised provider order entry (CPOE) on the educational experiences of medical trainees who work and train in AMCs. METHODS: We conducted semi-structured interviews of postgraduate trainees and attending physicians in internal medicine at five AMCs (two with CPOE, three without CPOE). Trainees routinely rotate from CPOE to non-CPOE AMCs, whereas some attending physicians work at both types of AMC and are therefore well positioned to reflect on differences between CPOE and non-CPOE learning environments. Data collection and analysis used grounded theory methods. We sampled purposively until we achieved theoretical saturation. RESULTS: Our study included 11 residents and six attending physicians. Computerised provider order entry had both positive and negative impacts on five aspects of postgraduate training: (i) learning (better for medication interactions and availability of learning resources; worse for learning medication doses); (ii) teaching (more medication information available to enhance case discussions; fewer face-to-face teaching opportunities); (iii) feedback (improved ability to observe medication ordering behaviours to inform feedback; less provision of direct feedback); (iv) clinical supervision (facilitates efficient and safe supervision from a distance; may impede trainee independence), and (v) trainee assessment (increased opportunity to assess clinical decision-making and organisational skills). CONCLUSIONS: We identify five key educational themes that are positively and negatively impacted by CPOE. These themes form a conceptual framework that could be applied to define the educational impact of other health care quality and patient safety practices. This will help educators to identify educational opportunities and protect the safety of the training experience of residents in AMCs. SN - 1365-2923 UR - https://news.unboundmedicine.com/medline/citation/22803757/Computerised_provider_order_entry_and_residency_education_in_an_academic_medical_centre_ L2 - https://doi.org/10.1111/j.1365-2923.2012.04317.x DB - PRIME DP - Unbound Medicine ER -